2510-FM-BWM0028 Rev. 1/2012
Form
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
COLLATERAL BOND
For the Transportation of Hazardous Waste
To be completed by the Applicant:
Name of Company:
Location of Company:
(Municipality and State)
(County)
WHEREAS,
(Name of Company)
a (1) corporation, incorporated under the laws in the State of
(2)
(Partnership, Individual, Registered Fictitious Name Business)
with a principal place of business at
(Street Address)
,
(City, State, and Zip Code)
has filed an application for a license with the Commonwealth of Pennsylvania, Department of Environmental Protection
(hereinafter referred to as the "Department") under the provisions of the "Solid Waste Management Act", the Act of July 7,
1980, Act No. 1980-97, as amended (hereinafter referred to as the "Solid Waste Management Act"), to conduct the
transportation of hazardous waste within the Commonwealth of Pennsylvania.
NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS, that
(Name of Company)
(hereinafter referred to as "Licensee"), in consideration of the issuance of the aforesaid license and intending to be legally
bound hereby, is held and firmly bound unto the Department in the just and full sum of
($
)
Dollars, to the payment whereof, well and truly to be made, the Licensee does hereby bind
heirs, executors, administrators, assigns and successors, firmly by these presents:
(his, her or its)
NOW THE CONDITION OF THIS OBLIGATION is such that if the Licensee shall faithfully perform all of the
requirements of (1) the "Solid Waste Management Act", (2) the applicable rules and regulations promulgated thereunder,
(3) any order of the Department, and (4) the terms and conditions of the license issued thereunder and designated in this
bond (all of which are hereinafter referred to as the "law") and (5) such amendments or additions to the law as may
hereinafter be lawfully made, then this obligation shall be null and void, otherwise to be and remain in full force and effect.
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2510-FM-BWM0028 Rev. 1/2012
Form
LIABILITY UPON THIS BOND shall be for the amount specified herein, which is a penalty for noncompliance with
the law. Liability upon this bond shall continue at a minimum for the duration of the license or any renewal thereof and for
a period of one (1) year after the expiration of the license. The one year period of liability shall include and shall be
automatically extended for such additional time during which administrative or legal proceedings involving a violation of the
law by the transporter are pending.
AND FOR THE PURPOSE OF SECURING SAID OBLIGATION, the Licensee hereby deposits the following
collateral, in cash, in Certificate of Deposit, automatically renewable irrevocable bank letters of credit, or negotiable bonds
of the United States Government, the Commonwealth of Pennsylvania, the Pennsylvania Turnpike Commission, the
General State Authority, the State Public School Building Authority, or any municipality within the Commonwealth.
DESCRIPTION OF COLLATERAL
A)
Negotiable Bonds
Face Value
Current Market
Value
Letter of Credit No.
Amount
Name of Issue & Bond No.
Sub Total
B)
Letters of Credit
Bank
Sub Total
C)
Cash, Certified Check, Cashier’s Check, Treasurer’s Check
Cash
Check if
Bank
Check No.
Sub Total
Applicable)
Total Amount of Collateral:
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Amount
2510-FM-BWM0028 Rev. 1/2012
Form
The Secretary of the Department shall, upon receipt of deposits of securities, immediately place the same with the
State Treasurer, who shall receive and hold the same in the name of Commonwealth for the purposes for which such
deposit is made and in accordance with the terms of the Bond. Where securities deposited mature or are called, the State
Treasurer, at the request of the licensee, may convert such securities into other acceptable securities designated by the
licensee. The Licensee hereby nominates, constitutes and appoints the State Treasurer as its attorney in fact for the
purpose of endorsing and negotiating, liquidation, or an exchange of said securities or any part thereof, for the purpose of
exchange of collateral as aforesaid or in the event of forfeiture of this obligation under the terms of this Bond.
UPON THE HAPPENING OF ANY DEFAULT of the provisions, conditions and obligations assumed under this
Bond and the declaration of a forfeiture by the Secretary, or his designee, the period for appeal provided by law having
expired, the Licensee hereby authorizes and empowers the State Treasurer to liquidate the said collateral and deposit the
proceeds to the account of the Department as provided by law.
FURTHER, the Department reserves the right to require additional bonding from the Licensee, for any reason,
which shall be a supplement to and augment the amount of bond provided herein. Nothing herein shall limit or preclude
the Department from seeking any penalty, liability or remedy, in addition to the forfeiture of this Bond, which may be
authorized or provided by law.
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2510-FM-BWM0028 Rev. 1/2012
Form
IN WITNESS WHEREOF, the Licensee hereunto sets its hand and seal, intending to be legally bound hereby, this
day of
20
ATTEST OR WITNESS
.
HAZARDOUS WASTE TRANSPORTER
(Name of Company)
By:
(Type Name)
(Type Name and Title)
(Signature of Above)
(Signature of Above)
By:
(Type Name)
(Type Name and Title)
(Signature of Above)
(Signature of Above)
Approved as to legality and form:
Office of Attorney General
Chief Counsel/Assistant Counsel
Department of Environmental Protection
APPROVED FOR THE DEPARTMENT:
(Signature)
(Title)
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